The risk of losing access to crucial means-tested programs — like Medicaid, Supplemental Security Income (SSI), the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF) — poses a barrier to the enrollment of low-income Americans in clinical trials. This burden likely disproportionately affects members of racial and ethnic minority groups, people with disabilities, elderly individuals, and rural populations, and may frustrate efforts to reflect the US population in clinical trial enrollment. To help achieve representative clinical trials for myriad conditions, Congress should pass legislation excluding payments to clinical trial participants from gross income and expand the clinical trial compensation exclusions for means-tested programs established in the Ensuring Access to Clinical Trials Act of 2015.

In the ethics literature, concern about financial compensation has largely focused on the question of how payment could distort research participants’ perception of risk. Such concern about “undue inducement” has particularly occupied institutional review boards (IRBs) and has often led to conservative judgments about how much financial compensation participants can be offered in exchange for their participation in research. Increasingly, bioethics scholars have argued that such approaches to financial compensation in research could exploit participants, on one hand, or create a barrier to their enrollment, on the other. Despite the vast literature on financial compensation for research, there has been substantially less attention to the potential risk that such payment may pose to research participants. The current system of taxing research compensation is one important example of the financial risks to research participants that warrants more analysis and legislative action.

In his widely anthologized article on the therapy-enhancement distinction, Resnik argues that, from a moral point of view, the claim that something is not health related cannot be a dispositive argument against the permissibility of enhancements. He further states how the permissibility of an intervention will depend on considerations like the intention for its use and the likely consequences that will ensue, and whether these violate any moral standards. Within this framework, in this paper I first argue that enhancements may be morally permissible on autonomy grounds (its political conception); and secondly, that this permissibility does not dissolve a moral distinction between therapies and enhancements, with the reason being that there is still a difference between something being generally permissible (i.e., therapies) and something being conditionally permissible (i.e., enhancements). But that is not all that is important for a moral therapy-enhancement distinction. I also argue that the distinction — apart from being about “permissibility” (at the level of regulation of individual use) — is also about regarding justice more broadly (at the level of what is owed to individuals). What captures the moral distinction more fully is that therapies are, generally speaking, not only morally permissible but also owed to persons (due to being enablers of social cooperation and competition), whereas, at this stage, enhancements can only be morally permissible. I demonstrate the appeal of this view by considering its stability and usefulness across specialized bioethical contexts and across various kinds of enhancements and show that its practical value for policy lies in its legitimizing / anticipatory and prioritizing functions.

In his paper “Moral Permissibility and Desert in the Therapy-Enhancement Distinction,” Ozan Gurcan takes a fresh look at the therapy-enhancement distinction and argues that, while the distinction does not establish rigid moral boundaries, it nevertheless serves an important purpose because it differentiates between interventions that are, generally speaking, owed to individuals as a matter of justice (i.e., therapies) and those that are not (i.e., enhancements). Because therapies help to promote justice in society, therapies are always permitted and, in many cases required, whereas enhancements may be, at best, permitted. In this commentary, I argue that we would be concerned about the morality of genetic enhancements even if they did not raise issues of social justice and I propose that other key moral ideas, such as the concept of human nature, may also be important in establishing the boundary between therapy and enhancement.

As surrogacy grows, many states and countries are enacting or considering relevant regulations, while others oppose it. Ethical, legal and policy questions arise: how to balance the rights of various kinds of parents (e.g., heterosexual and same-sex couples and single individuals) against the rights and well-being of surrogates. Concerns include risks of exploitation, autonomy, benefits of enabling prospective parents to create loving families, and mitigating possible harms through regulations. Though a few instances of abuse have been reported in developing countries, these do not appear to have occurred in developed countries, where robust regulations exist. The limited data available on surrogates in general (i.e., including traditional and non-commercial surrogacy) do not suggest exploitation or trafficking. In 2021, New York State enacted robust regulations allowing commercial surrogacy. Subsequent competing bills have sought to loosen or enhance certain restrictions. These regulations may be a model for commercial surrogacy regulations elsewhere, but certain ethical, legal and policy questions remain (e.g., where to draw the line to prevent trafficking). Additional data and exploration of these challenges are crucial

In the aftermath of the Supreme Court’s decision ending federal constitutional protection for abortion, interstate and federal-state conflicts are revealing the importance of federalism to reproductive justice. This shift has implications for health and social science research agendas because scientific evidence plays a less significant role in disputes over which government actor is empowered to regulate reproduction than it does in conflicts over reproductive rights.

Hot tap water is the most common source of scald injuries, representing a quarter of all scald injuries requiring hospitalization in the United States. Children and older adults are at increased risk of scald burns. Evidence suggests that poor knowledge of burn risks and treatment among parents and the public may contribute to the burden of scald injuries in children. Medical and injury surveillance categorizes most scald burns as unintentional injuries. However, scald burns can also lead to investigation by the justice system if the injury is suspected to result from abuse or neglect. The Department of Justice recommends assessing criminal intent in childhood scald burns based on traditional indicators derived from medical research: burn uniformity, areas of sparing, burn locations, family history, and speed of medical care. In this study, we present an overview of the existing literature on intentional scald burns in children caused by hot tap water in order to improve their identification and prevention. This systematic review aims to answer two questions: (1) What are the indicators of intentional scald burns in children according to the literature and (2) Is the body of evidence for common indicators of intentional scald burns subject to bias?

Shields and colleagues raise a concern for bias against low-income families when reporting suspected intentional scald burns. This is a plausible theory, and the development of Child Abuse Pediatrics as a specialty has likely helped reduce bias because they take the sociodemographic factors into account and are keenly aware of housing problems such as water heaters that are not regulated. Bringing their expertise to burn units will help reduce bias, and efforts should focus on public policy changes as described by the authors, but also on parental education to reduce the overall incidence of burn injuries in children.

Recent literature describes the controversy relating to brain death/death by neurological criteria (DNC), which some have referred to as “widely accepted, but not universally supported.” This article provides an overview of differences in state laws relating to DNC and describes recent proposals to reform the definition of brain death. In 2023, the American Academy of Neurology (AAN) issued clinical guidelines stating that clinicians may declare a patient DNC despite evidence of neuroendocrine function — a position that directly conflicts with state law requirements for determining death. This article offers a critical analysis of AAN guidelines, an update on proposals to reform the Uniform Determination of Death Act, and explains why policy discussions should include how DNC exams occur in practice. Research suggests there are flaws with current clinical testing methods, which contributes to two separate problems: (1) false positives from insufficient testing, and (2) inadvertent misdiagnosis from unintentional errors. Together, this has produced confusion and reduced public trust in the concept of brain death. This article provides recommendations to clarify and retain the current legal standard for brain death, explains the ethical importance of accurate standards for determining DNC, and offers practical solutions to reduce errors.

In their article, Drabiak et al. review the state laws and ethical debates related to the determination of death by neurologic criteria, analyze the recent 2023 American Academy of Neurology practice guidelines, and make policy recommendations. We call this review ‘just’ because the article correctly focuses on the chief ethical, legal, and medical issue in this debate — namely whether patients declared dead by neurological criteria are actually dead, along with the need to improve integrity, honesty, trust, and residency education and training to reduce moral distress and achieve moral certainty in declaring patients dead, initiating organ procurement, and communicating these realities to patient families/surrogates. As the authors invite the reader to comprehend, it should no longer be considered a minority or fringe opinion that determinations of brain death are rife with false positives, inadvertent misdiagnoses, violations of informed consent, and, ultimately, dissent from the law. For the sake of justice, one would do well to heed these words.

Psychedelic treatment with psilocybin is receiving increased attention following clinical trials showing it may help treat end-of-life anxiety, depression, and several other conditions. Despite this, physicians may be reluctant to prescribe psilocybin and carry out psilocybin treatment because of the stigma surrounding psychedelics and the potential for medical malpractice liability. This paper explores whether psilocybin treatment gives rise to a risk of medical malpractice liability for physicians. Following an overview of psilocybin treatment and its regulatory regime in Canada, exploratory vignettes are used to highlight the relevance and limits of malpractice claims. This paper argues that the lack of established medical standards, standardized training, and credentialing contribute to liability risks surrounding psilocybin treatment. More clinical trials, meta-studies of research analyses, and knowledge sharing will help to develop training programs and medical standards of practice to better realize psilocybin’s potential.

Psychedelics are becoming increasingly available within approved regulatory pathways and in “underground” or recreational settings. However, clinicians’ knowledge and training is insufficient, leading to limitations when discussing benefits and harms with patients. These insufficiencies also create liability risks for clinicians which may be heightened if, as anticipated, the federal government deregulates psychedelics. In light of rapidly changing conditions, stakeholders should work together to increase public and clinical education. Stakeholders should also develop pathways for widely available post-trip counseling services. Such pathways should address the needs of users struggling to process the ongoing emotional and neuropsychiatric effects of their psychedelics experience which can sometimes be disabling. Thoughtful and timely collaboration can lay the groundwork for psychedelic medicine, a newly developing area of clinical practice.

This paper considers whether assisted suicide and euthanasia (AS/E) is an area for medical regulation or whether there is a better alternative regulatory mechanism to govern it. Drawing from empirical evidence across a range of jurisdictions where it is legalized, the paper argues that there are at least four good reasons to consider demedicalizing AS/E: (1) pragmatic ethical issues of infrastructural weakness in AS/E service provision in already overstretched healthcare systems globally; (2) challenges of medicalization; (3) regulatory complexities concerning medical law (including pharmaceutical law) and criminal law; (4) the risk that AS/E becomes more easily susceptible to healthcare economics. The paper suggests several recommendations concerning a possible “demedicalized model.”

The article “Is Assisted Dying Really a Matter for Medical Regulation” provides four arguments for the demedicalization of Assisted Dying (AD). Giwa, Myers, and Teaster counter, arguing that demedicalization will increase regulatory complexities if “non-medics” are at the helm and that AD will not be any less susceptible to healthcare economics.

Epidemiological research supports a correlation between increased strength of democracy and improved population health. In their recent article, “Democracy Matters for Child Health,” Hoops and colleagues build on this existing evidence base to demonstrate that democracy improves child health in particular. We agree and further argue that public health and child health advocates should be particularly concerned with antidemocratic threats to women’s rights and policies that undermine gender equity.

Climate change-related environmental harms have been observed to negatively affect mental health. While policymakers and courts around the world widely recognise the impacts of climate change on physical heath as potentially endangering human rights, the implications of climate change for mental health have received significantly less attention. This paper analyzed five cases that challenged national response to climate change and the resulting impacts on mental health before four different international human rights protection bodies. Four out of these five cases were dismissed either because the petitioners did not seek prior action before the national authorities, or because their claims were deemed unsubstantiated. Despite these outcomes, the protection bodies’ treatment of these petitions as well as various other ongoing developments show that the human rights approach to climate change and mental health is gradually emerging at the international and domestic levels, but it is still in its early days and there are various challenges to it.

Human rights courts may be on the cusp of recognizing linkages between the mental health impacts of climate change and human rights. However, several significant obstacles must be overcome before human rights protections are likely to be extended to cover the mental health impacts of climate change. Thus, the push for recognition of human rights protections for people facing mental health harms imposed by climate change must be pursued along with a multifaceted effort that employs regulatory and advocacy strategies alongside litigation, and more clearly establishes the interconnections between mental health, climate change, and human rights.